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4 Results for Health Topics

4.7 Injury and physical rehabilitation

4.7.1 Injury and physical rehabilitation

  • The combined search strategies captured a large number of peer-reviewed articles broadly related to injury and rehabilitation (n=4798). Following full review, a combined total of 47 articles met the inclusion criteria, and were related to injury and rehabilitation-related public health interventions in humanitarian crises.
  • A small number of papers (n=18) evaluated health outcomes and quoted some form of significance test (category A).
  • 29 articles described health outcomes following surgical, medical, and rehabilitative interventions, but did not draw a statistical association between the intervention and the stated outcome (category B).
  • Each paper was quality-assessed using an adaptation based on the STROBE criteria for observational studies. Only 4% (n=2) papers were of high quality. No papers met the full STROBE criteria as sample size calculations were often absent.
  • Both the quantity and quality of papers increased over the course of the last 23 years. 57% (n=27) of the papers in this study were published between 2000 and 2013. 81% (n=38) of the higher quality studies were published between 2000 and 2013 (Figure 21).
  • The majority of studies were cross-sectional in design (n=30; 64%), followed by uncontrolled longitudinal studies (n=11; 23%). A single economic study investigated the cost-effectiveness of short-term orthopaedic missions in relief and elective contexts. Five studies were non-random trials.
  • The majority of studies were based on injuries seen in Asia (n=16; 34%). Ten of the Asian studies (63%) were specifically related to the 2008 Wenchuan Earthquake, Central China. The second most studied region was Eastern Europe, with 14 studies (30%). All of these studies related to conflict in the Former Yugoslavia in the 1990s. See Figure 22.
  • 62% (n=29) of the studies were conducted in conflict settings, or with patients who had suffered conflict-related injuries.
  • The majority of papers reviewed or collected data from the acute phase of a crisis (n=39; 83%). A small number of papers looked at health outcomes in the early recovery and stabilisation phases (n=4 and n=4 respectively). No papers were identified that examined the relationship between preparedness and health outcomes (See Figure 23).
  • 98% of the papers described interventions for the general population (n=46).
  • The majority of the papers were set in a mixed urban-rural environment (n=34; 72%). Four papers focused specifically on urban areas, while a further 9 papers focused on rural settings.
  • The majority of the papers examined a range of orthopoedic injuries (n=15; 32%), of which the repair of fractures featured prominently (Figure 24).
  • Twenty-two of the fourty seven studies described a range of surgical interventions (47%). Six papers looked at surgical external and internal fixation techniques in particular (13%). This type of operation was the focal point of published research more frequently than any other complex surgical technique. Nine papers described different forms of renal therapy, and / or fasciotomy (19%). A further four papers looked at health outcomes following limb amputation specifically (9%), while four papers evaluated different forms of rehabilitation (9%) (Figure 25).
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